Abstract
Introduction: Penile Cancer constitutes less than 1% of malignancies in British men. Surgical options are penile preserving surgery or penectomy. Although penile conserving surgery has a higher cancer recurrence rate, it is believed, but not proven, that it provides better functional results with less impact on psychosexual function, masculinity and quality of life than penectomy.Method: 74 men (mean age=63.8, SD=1.76) were measured for Conformity to Male Norms (CMNI) as a possible risk predictor of psychological outcomes in men who have had surgical treatment for penile cancer. Outcome measures were: Demographic questions, Quality of Life (QoL) (QLQ-C30); anxiety and depression [Hospital Anxiety and Depression Scale, (HADS)]; and self-esteem [Rosenbergs Self Esteem Scale (RSE)]. Sub-groups were based on surgical procedure: conservation/reconstruction (CR) n=15; partial penectomy (PP) n=46; total penectomy (TP) n=12 (1 unallocated). Sixteen retrospective, cross sectional and twenty four prospective, longitudinal interviews were conducted to explore the impact of penile surgery on perceived masculinity, and psychological well-being.
Results: Employment was significantly related to increased quality of life and self-esteem, having a partner was related to increased but low levels of anxiety. The extent of the surgery did not significantly affect psychological outcomes. All psychological outcomes had sub clinical values. The level of masculine conformity was positively and significantly related to anxiety. Higher sub domain scores of the conformity to male norms inventory; power over women and self-reliance were positively correlated to increased depression. Disdain of homosexuality was positively predictive of depression. Increased conformity to self-reliance and violence were positively predictive of increased anxiety. Conforming to, power over women and disdain of homosexuality were related to lower self-esteem and increased self-reliance was positively predictive of lower self-esteem. Qualitative data suggested global masculinity remained unchanged; however, individual concepts of masculinity were reframed using a system of reprioritising the importance of affective and effective masculine traits. Previous constructs of self and being were replaced with new alternative constructs that were considered adaptive to the treatment sequelae.
Conclusions and Clinical Implications: The extent of penile surgery can be a trade-off between preserving penile length and preserving length of life. Bio-psychosocial and sexual quality of life and well-being can be achieved independent of the extent and severity of penile surgery. As yet, there are no psychometric tools or intervention pathways to assess and treat psychological and masculine vulnerability in men diagnosed with penile cancer. Measuring individual constructs of masculinity may predict psychological adjustment and contribute to the development of a standardised risk assessment tool. Therapeutic interventions are suggested by developing and supporting masculine profiles that indicate successful psychological adjustment for optimal survival.
| Date of Award | 16 Jan 2013 |
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| Original language | English |
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| Supervisor | Kathryn Bullen (Supervisor) & Rachel Rahman (Supervisor) |